Garg Prashant, Kalra Paavan, Joseph Joveeta
Tej Kohli Cornea Institute, L. V. Prasad Eye Institute, Hyderabad, Telangana, India.
Jhaveri Microbiology Centre, L. V. Prasad Eye Institute, Hyderabad, Telangana, India.
Indian J Ophthalmol. 2017 Nov;65(11):1079-1086. doi: 10.4103/ijo.IJO_826_17.
The purpose of the study is to describe epidemiology, clinical features, diagnosis, and treatment of Acanthamoeba keratitis (AK) with special focus on the disease in nonusers of contact lenses (CLs). This study was a perspective based on authors' experience and review of published literature. AK accounts for 2% of microbiology-proven cases of keratitis. Trauma and exposure to contaminated water are the main predisposing factors for the disease. Association with CLs is seen only in small fraction of cases. Contrary to classical description experience in India suggests that out of proportion pain, ring infiltrate, and radial keratoneuritis are seen in less than a third of cases. Majority of cases present with diffuse infiltrate, mimicking herpes simplex or fungal keratitis. The diagnosis can be confirmed by microscopic examination of corneal scraping material and culture on nonnutrient agar with an overlay of Escherichia coli. Confocal microscopy can help diagnosis in patients with deep infiltrate; however, experience with technique and interpretation of images influences its true value. Primary treatment of the infection is biguanides with or without diamidines. Most patients respond to medical treatment. Corticosteroids play an important role in the management and can be used when indicated after due consideration to established protocols. Surgery is rarely needed in patients where definitive management is initiated within 3 weeks of onset of symptoms. Lamellar keratoplasty has been shown to have good outcome in cases needing surgery. Since the clinical features of AK in nonusers of CL are different, it will be important for ophthalmologists to be aware of the scenario wherein to suspect this infection. Medical treatment is successful if the disease is diagnosed early and management is initiated soon.
本研究的目的是描述棘阿米巴角膜炎（AK）的流行病学、临床特征、诊断和治疗，特别关注非隐形眼镜使用者的该疾病情况。本研究是基于作者经验及对已发表文献的回顾而进行的前瞻性研究。AK占微生物学确诊角膜炎病例的2%。外伤和接触受污染的水是该疾病的主要诱发因素。仅在一小部分病例中可见与隐形眼镜的关联。与经典描述相反，印度的经验表明，超过三分之一的病例中不会出现不成比例的疼痛、环形浸润和放射状角膜神经炎。大多数病例表现为弥漫性浸润，类似单纯疱疹或真菌性角膜炎。通过对角膜刮片材料进行显微镜检查以及在覆盖有大肠杆菌的无营养琼脂上进行培养可确诊。共焦显微镜检查有助于诊断深部浸润的患者；然而，该技术的经验以及图像解读会影响其实际价值。感染的主要治疗方法是使用双胍类药物，可加用或不加用脒类药物。大多数患者对药物治疗有反应。皮质类固醇在治疗中起重要作用，在适当考虑既定方案后可在有指征时使用。症状出现后3周内开始确定性治疗的患者很少需要手术。板层角膜移植术在需要手术的病例中已显示出良好的效果。由于非隐形眼镜使用者中AK的临床特征不同，眼科医生了解怀疑这种感染的情况非常重要。如果疾病早期诊断并尽快开始治疗，药物治疗是成功的。
